Bowel obstruction

Question 1

Small bowel obstruction bowel sounds

Answer 1

Tinkling bowel sounds - rain on a tin roof

Question 2

which type of bowel obstruction is more common

Answer 2

small bowel obstruction

Question 3

What is small bowel obstruction (SBO)?

Answer 3

A blockage of the small intestine that prevents the normal passage of intestinal contents (fluid, food, gas)

Question 4

What are the classic symptoms of SBO?

Answer 4

Diffused abdominal pain
vomiting
abdominal distension
constipation/failure to pass flatus or stool

Question 5

The big three causes of bowel obstruction

Answer 5

Adhesions (post-surgery)
hernias
malignancy

Question 6

Abdominal X-ray findings of Small Bowel Obstruction

Answer 6

• Valvulae conniventes - Mucosal folds - (line across full width of the bowel
• Central dilated loops
• > 2.5cm
• “string-of-beads sign” - small pockets of gas in fluid-filled small bowel

Question 7

Abdominal X-ray of large bowel obstruction

Answer 7

• Haustra - Pouches formed by muscles does not extend full width
• Dilated peripheral loops
• > 9 cm at caecum
• > 6 cm at rest of colon

Question 8

Define mechanical bowel obstruction

Answer 8

Mechanical obstruction: blocking arising from structural abnormality acting as a physical barrier to progression of bowel contents

Question 9

Define pseudo-obstruction

Answer 9

Pseudo-obstruction: paralytic ileus/functional, no physical obstruction

Question 10

When can closed loop bowel obstruction occur

Answer 10

• when a obstruction is formed at two different parts of the bowel by adhesions
• when a competent ileocecal valve is presence in LBO

Question 11

what complication can closed bowel obstruction leads to

Answer 11

perforation

Question 12

Bowel obstruction management

Answer 12

Resuscitation
(IV fluids and electrolyte replacement, O2), analgesia, NBM

Fluid balance with urinary catheter for output monitoring

NGT insertion in GOO, SBO, LBO if incompetent ICV or vomiting​

Definitive management

• Adhesion – conservative management, gastrograffin study
• Sigmoid volvulus - decompression using flatus tube or flexible sigmoidoscopy/Surgery
• Stricture – dilatation (+/- stenting)
• Ileus – correct electrolytes, mobilise, review medications that reduces motility
• Surgical resection

Question 13

Most common causes of LBO

Answer 13

• Colon tumours
• diverticular strictures

Question 14

Define Colectomy

Answer 14

Total colectomy: Removal of the entire colon.

Partial (subtotal) colectomy: Removal of a segment of the colon.

Hemicolectomy: Removal of the right or left portion of the colon.
This surgery may be performed for conditions such as cancer, inflammatory bowel disease, or severe infection

Question 15

Define Small Bowel Resection

Answer 15

A small bowel resection is a surgical procedure to remove a diseased or damaged portion of the small intestine. The healthy ends are then rejoined (anastomosis). This is commonly done for strictures, blockages, Crohn’s disease, or tumors

Question 16

Define Colostomy

Answer 16

Creation of an opening (stoma) from the colon (large bowel) to the abdominal wall for stool drainage.

• Usually on the left side
• Usually formed or soft faeces
• Bowel function can be 2-3 times a day
• Pouch change depends on the types of bag used

Question 17

Define Ileostomy

Answer 17

Creation of an opening (stoma) from the ileum (small bowel) to the abdominal wall for stool drainage

• Usually on the right side
• Should be spouted (2.5cm)
• Usually loose, porridge like consistency
• Bowel function 4-6 x day (might be higher)

Question 18

What is the Rigler’s sign

Answer 18

A sign of pneumorperitoneum (gas is present in the bowel wall)